Fatal MI More Likely After Sibling Dies

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By Crystal Phend, Senior Staff Writer, MedPage Today

Published: February 27, 2013

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania

Action Points

  • Because the death of sibling is a stressful life event, this study looked at the association between loss of an adult sibling and mortality from myocardial infarction up to 18 years since bereavement.
  • The study provided found evidence for mortality from myocardial infarction associated with the death of a sibling at adult age.

The death of an adult brother or sister may boost one’s own risk of dying from a heart attack in the following years, a population-based study showed.

The fatal heart attack risk was 25% higher for women and 15% higher for men who had experienced death of an adult sibling, Mikael Rostila, PhD, of Stockholm University and the Karolinska Institutet in Stockholm, and colleagues found.

The impact wasn’t seen in the first months of bereavement but was in the roughly 1 to 3 years afterward, the group reported online in the Journal of the American Heart Association.

Shared risk factors may have been partly to blame; but whatever the mechanism, physicians need to keep an eye on their patient’s heart after a loss, Rostila and colleagues recommended.

“It is important for healthcare workers to follow bereaved siblings after the death of a sibling and recognize signs of acute or chronic psychosocial stress mechanisms that could lead to risk of myocardial infarction,” they suggested.

“Triggered cardiovascular events might be prevented with traditional cardiovascular medications (aspirin, beta-blockers, statins) and by stress management.”

Given well-known risks from loss of a spouse, parent, or child, Rostila’s group looked to see if the same would hold for siblings.

Their study included all 130,920 Swedes ages 40 to 69 years who lost a sibling between 1981 and 2002, based on national registry data, along with a 10% sample of nonbereaved adults.

The raw myocardial infarction (MI) mortality rate was roughly doubled among those who had an adult sibling die during that period, at 0.85 versus 0.45 per 1,000 person-years for men and 0.24 versus 0.11 per 1,000 person-years for women.

After controlling for number of siblings and other factors, the rate ratio for death from MI was 1.25 among bereaved women (95% confidence interval 1.02 to 1.28) and 1.15 among bereaved men (95% CI 1.03 to 1.28) compared with controls.

The risk of death from MI afterward appeared to have peaks around year 1 and year 3 for men, with about a 30% higher risk over those years, albeit not statistically significant compared with controls.

The risk spiked among women in years 2 and 3 after their sibling’s death to about twice that of controls.

Neither gender group showed an immediate or late impact after their sibling’s death.

Differences between men and women are plausible, based on prior studies suggesting that the risk period after bereavement is more prolonged for women, perhaps due to their greater emphasis on social relationships with the family, the researchers noted.

Mechanisms might include changes to the sympathetic nervous system that induce inflammation as well as negative coping responses, such as smoking, drinking more, and poor diet and exercise habits after bereavement, they wrote.

However, shared genetic and environmental exposure earlier in life may play a role too.

At least part of the association between loss of an adult brother or sister and death from MI appeared to be due to confounding from shared predisposition.

For men, the risk of fatal MI was elevated much more in the setting of bereavement if the sibling had also died from MI than if the sibling had died from any other cause. The rate ratio was 1.98 versus 0.84 in the setting of sibling death from an accident or other external cause, and 1.05 for non-MI deaths.

Women also showed a higher risk of MI death if their sibling died from the same cause, with a rate ratio of 1.62 versus nonbereaved persons.

Both sexes likewise showed a relatively strong link between death from MI and death of a sibling from other cardiovascular causes (rate ratio 1.74 for men and 1.50 for women, albeit not significant among the latter).

But women still showed an impact of bereavement of a sibling on MI mortality even when the brother or sister had died from an external cause, especially if it wasn’t suicide (rate ratios 1.54 and 1.86, respectively).

Limitations of the study included lack of data on comorbidities, severity of bereavement, or psychiatric screening; and inability to look at nonfatal MI.

Rostila reported receiving funding from the Swedish Council for Working Life and Social Research and the Swedish Research Council.

The researchers reported having no conflicts of interest to disclose.

Primary source: Journal of the American Heart Association
Source reference:
Rostila M, et al “Mortality from myocardial infarction after the death of a sibling: A nationwide follow-up study from Sweden” JAMA 2013.

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